Clinical Trial of Losartan for Pulmonary Emphysema: Pulmonary Trials Cooperative Losartan Effects on Emphysema Progression Clinical Trial
Authors: Robert A. Wise, Janet T. Holbrook, Robert H. Brown, Gerard J. Criner, Mark T. Dransfield, Jiaxian He, Robert J. Henderson, David A. Kaminsky, Robert J. Kaner, Stephen C. Lazarus, Barry J. Make, Meredith C. McCormack, Enid R. Neptune, Loretta G. Que, Nicola Hanania, Marianna Sockrider, Laura Bertrand, Mustafa Atik, Emily DiMango, Tarnjot Saroya, Joan Reibman, Karen Carapetyan, Robert J. Kaner, Fernando J. Martinez, Xiaoping Wu, Alicia J. Morris, Elizabeth M. Peters, Matthew Marcelino, Loretta G. Que, Anne Mathews, Devon Paul, Isaretta Riley, Timothy Scialla, Catherine Foss, Antoinette Santoro, Eli Morgan, Erika Coleman, Ravi Kalhan, Sharon Rosenberg, Lewis Smith, Jenny Hixon, Edward Naureckas, Virginia Zagaja, Jerry Krishnan, Valentin Prieto-Centurion, Lourdes Norwick, Aileen Baker, Lauren Castro, Julie DeLisa, Wendy Hasse, Sai Illendula, James Moy, Christopher Codispoti, Ben Xu, Kyle Happel, Matthew Lammi, Richard Tejedor, Sarah Jolley, Connie Romaine, Barry J. Make, Flavia Hoyte, Jennifer Underwood, Linda Rogers, Sonali Bose, Sidney Braman, Jessica Harris, Gwen Skloot, Chelsea Chung, Deelan Ayhan, Diana Valerio, James Cury, Vandana Seeram, Fallon Wainwright, Katrina Maloney, Kaharu Sumino, Brenda Patterson, Mario Castro, Leonard B. Bacharier, Jaime J. Tarsi, Mario Castro, Vanessa Curtis, Michael Busk, Ellen Looney, David A. Kaminsky, Anne E. Dixon, Charles Irvin, Erika Gonyaw, Stephanie Burns, Kathy Meehan, Douglas Kahn, John Chronakos, Guillermo Ballarino, Loren Inigo-Santiago, Sakshi Sethi, Thomas Botta, Margaret Mukwaya, Laura Feemster, David Au, Lucas Donovan, Amber Lane, Ed Udris, Gerard J. Criner, Helga Criner, Divay Chandra, Craig Riley, Jessica Bo. Field, Elizabeth Stempkowski, Mark T. Dransfield, Surya Bhatt, Anand Iyer, Taku Mkorombindo, James Wells, Necole Harris, Lynn B. Gerald, Monica Kraft, Afshin Sam, Michele Simon, Natalie S. Provencio-Dean, Amber J. Martineau, Joe Ramsdell, Xavier Soler, Stephen C. Lazarus, Prescott Woodruff, Julian Silva, MeiLan Han, Catherine Meldrum, Wassim Labaki, Gretchen Bautista, Kelly Rysso, Crystal Cutlip, Thomas B. Casale, Juan Carlo. Cardet, Claudia Gaefke, Dennis Ledford, Richard Lockey, Amber Pepper, Shiven Patel, Tara Saco, Kirk Shepard, Raul Villarreal, Emma Westerman, Catherine Rene. Smith, William C. Bailey, Robert A. Wise, Janet T. Holbrook, Alexis Rea, Anne Shankli. Casper, Jiaxin He, Robert J. Henderson, Andrea Lears, Jill Meinert, David Shade, Emily Szilágyi, Joy Saams, Ashley McCook, Robert J. Henderson, Dong-Yun Kim, Andrew H. Limper, Gordon Bernard, Joao A. de Andrade, Deborah R. Barnbaum, Daren L. Knoell, Peter Lindenauer, Irina Petrache, Andre Rogatko, Marinella Temprosa
Journal: American Journal of Respiratory and Critical Care Medicine (2022)

Rationale: There are no pharmacologic agents that modify emphysema progression in patients with chronic obstructive pulmonary disease (COPD). Objectives: To evaluate the efficacy of losartan, an angiotensin receptor blocker, to reduce emphysema progression. Methods: The trial was a multicenter, randomized, placebo-controlled trial conducted between May 2017 and January 2021. Eligible participants were aged ⩾40 years, had moderate to severe airflow obstruction, ⩾10 pack-years of smoking, mild-moderate emphysema on high-resolution computed tomography, and no medical indication for or intolerance of angiotensin receptor blockers. Treatment with losartan 100 mg daily or matching placebo (1:1) was randomly assigned. The primary outcome was emphysema progression on high-resolution computed tomography over 48 weeks. Secondary outcomes included the St George's Respiratory Questionnaire, the modified Medical Research Council dyspnea scale, the COPD Assessment Test, and the Physical Function–Short Form 20a. Measurements and Main Results: A total of 220 participants were enrolled; 58% were men, 19% were African American, and 24% were current smokers. The medians (interquartile ranges) for age were 65 (61–73) years and 48 (36–59) for percent predicted FEV1 after bronchodilator use. The mean (95% confidence interval) percentage emphysema progression was 1.35% (0.67–2.03) in the losartan group versus 0.66% (0.09–1.23) in the placebo group (P = NS). Conclusions: Losartan did not prevent emphysema progression in people with COPD with mild-moderate emphysema. Clinical trial registered with www.clinicaltrials.gov (NCT02696564).